Abstract: Abstract
Countermeasures for pressure ulcers, which have been promoted as a national policy in Japan since 2002, have reduced the development of new pressure ulcers due to insufficient observation or treatment. On the other hand, it has become clear that pressure ulcers continue to develop in patients with cancer.
We evaluated 419 patients (of whom 202 had cancer) who had newly developed pressure ulcers. The following results were obtained. (1) Among patients with terminal illnesses, cancer patients outnumbered non-cancer patients. (2) There was no difference between the cancer patient group and the non-cancer patient group, in the time required to heal ulcers. (3) There was also no difference between the groups in the time from the development of pressure ulcer until the patients died. (4) Cancer patients were more likely to develop pressure ulcers comparing to patients without cancer, even though their risk scores analysis were not high.
In addition to providing enough anodynes and sedatives, and extra-soft mattresses, it is necessary to modify risk-assessment measures, because cancer is a risk factors pressure ulcers.
Abstract: Gluteal FC rotation flaps can still be used for the closure of sacral pressure ulcers, but they tend to develop a large dog-ear on the buttock. We present a new method of avoiding a dog-ear deformity ( Burow’s triangles ) while achieving adequate repair of pressure ulcers on the buttock by using a modification of the bilobed rotation flap.
This "pigeon head" modification of the rotation flap successfully covered all 7 sacral ulcers. In all cases, Burow’s triangles were unobtrusive since immediately after surgery.
This technique is simple, can be performed quickly, has minimal associated morbidity, and yields a good outcome.
Abstract: We report a case of the flexor digitorum profundus tendon rupture of the little finger, which was predisposed by an anatomic variation of the tendon. Intraoperative findings and magnetic resonance imaging of the opposite hand suggested that the flexor digitorum profundus tendons of the ring and the little finger bifurcated. The patient had tendon reconstruction and regained function. We believe that reconstructing the tendon so that it resembles the normal anatomy prevents the recurrence of tendon rupture.
Abstract: OBJECTIVE: To present our experience of cavernous nerve graft reconstruction, using an autologous nerve vein-guide technique, to restore potency. PATIENTS AND METHODS: Prostate cancers frequently require radical resection involving one or both cavernous nerves that usually results in erectile dysfunction; nerve grafting has been used to restore erectile function, but clinical results are unsatisfactory owing to inadequate surgical techniques. In all, eight patients with prostate cancer who required radical resection involving one cavernous nerve had sural nerve grafting, with two or three sutures using the autologous vein-guide technique, in our unit between 2004 and 2005. Because of the difficulty of performing microsurgical manoeuvres deep within the pelvic cavity, the nerve anastomosis might be unsatisfactory. RESULTS: Seven of the eight patients had spontaneous erectile activity after grafting and six of these patients were able to have intercourse. CONCLUSION: Sural nerve grafting using the autologous vein-guide technique is simple, has minimal morbidity, and yields good outcomes.
Abstract: OBJECTIVE AND PATIENT: Both nasal cerebral heterotopia and encephalocele are rare congenital benign masses of neurogenic origin caused by an embryonic developmental abnormality. It is generally accepted that nasal heterotopia is a sequelae to encephalocele. This report presents an unusual case of nasal cerebral heterotopia and encephalocele arising in the same patient. The patient had a firm, solid mass measuring 1.5 x 1.0 cm on the bridge of the nose covered with normal skin and another mass in the nasal cavity obstructing the right nasal cavity. Computed tomography (CT) demonstrated that the nasal bone separated these masses. CT also showed a bony defect at the skull base. Surgery consisted of dividing the encephalocele and closure of the skull base fistulae, along with nasal subcutaneous mass enucleation. RESULTS: Intraoperative examination indicated the existence of a pit on the nasal bone where the pedicle of the nasal subcutaneous mass connected. Microscopic examination of the nasal cavity mass demonstrated meningoencephalocele, and examination of the nasal subcutaneous mass demonstrated nasal cerebral heterotopia, which was confirmed by immunohistochemical staining. After 10 months, complete removal of the subcutaneous nasal mass was recognized and there was no evidence of recurrence. CONCLUSION: Findings in this case suggest that the nasal cerebral heterotopias will result from encephalocele.
Abstract: We report a case of delayed brain atrophy after electrical injury. A 12-year-old boy sustained extensive burns by touching a high-voltage power line. The burn area comprised more than 60% TBSA, and he subsequently underwent several surgical procedures. Two months later, he suddenly developed seizures. Initial findings on magnetic resonance imaging showed diffuse cortical damage in the left brain. Two months later, motor aphasia appeared, and a second magnetic resonance imaging scan showed atrophy in the left temporal and frontal lobes. Owing to speech rehabilitation, the patient gradually recovered his capacity for speech. Eight months later, his speech was almost perfect. We believe that because the patient was young, early speech rehabilitation was effective.
Abstract: Introduction: Ameloblastomas comprise approximately 1% of all tumors of the jaw (Batsakis and McClatchey,1983). Many investigators have reported that approximately 80-90% of cases of ameloblastomas occur in the mandible with the remaining 10-20% in the maxilla (Kameyama et al.,1987). Bimaxillary ameloblastoma has never been reported.
Objective and patient: We report an unusual case of ameloblastomas arising in both maxilla and mandible. Radiographic findings showed features consistent with a benign, fibro-osseous lesion. Treatment consisted of a left hemimandibulectomy with iliac bone free flap reconstruction for the mandibular tumor, and simple resection for the maxillary tumors.
Results: After ten months, complete union of the vascularized bone segments with the recipient bones was recognized. The incisal opening was 40mm with slight left mandibular deviation, and there was no evidence of recurrence.
Conclusion: This paper is thought to be the first report of bimaxillary ameloblastoma.
Abstract: We present two cases of aggressive myofasciitis after gastrointestinal infections. The first patient developed necrosis of the legs over 5 days and he died on the 20th day. Vibrio vulnificus was cultured. The second patient developed bullae on his thigh and he died the next day. Streptococcus pyogenes was cultured.
Abstract: Five pilomatrixomas with anetodermic cutaneous changes are presented. Four large tumors revealed soft, atrophic, pink translucent skin covering a firm subcutaneous mass, and their appearance was similar to that of a keloid or hypertrophic scar. One small tumor revealed soft, slightly atrophic, reddened or purplish skin covering a firm subcutaneous mass: its clinical appearance was similar to that of a hematoma or minor infection. Histopathological examination of the skin showed atrophic and edematous changes in the dermis associated with diminished fragmented collagen and absent elastic tissue. It is supposed that the dermal atrophic appearance bears a relation to the loss of elastic fibers and the dermal edema is related to the leakage of lymphatic fluid. Both phenomena may be caused by continuous pressure from the outside, as these anetodermic pilomatrixomas were located where they were apt to be exposed to mechanical irritation.
Abstract: Keloids are benign dermal tumors, characterized by overgrowth of lesions, invasiveness beyond the original boundary of the insult, and recurrence of lesions. The exact etiology is unknown, however. Our hypothesis is that keloids are acquired as a result of an abnormal or prolonged wound healing process, with persistent proliferation and extracellular matrix production of fibroblasts that should otherwise discontinue in normal wound healing. In this study, we examined the response of keloid fibroblasts to proapoptotic signaling. Cell-permeable ceramide, N-acetyl-D-sphingosine, induced apoptosis of dermal fibroblasts in a dose- and time-dependent manner, which was detected by phase contrast microscopy, fluorescent microscopy, the TUNEL method, flow cytometric analysis, and WST-1 assay. In contrast, keloid fibroblasts resisted apoptosis induced by N-acetyl-D-sphingosine (percent survival with 40 mM ceramide treatment for 12 h, normal versus keloid: 9.6% +/- 6.6% vs 66.8% +/- 5.5%). Western blotting analysis showed insulin-like growth factor I receptor overexpression in keloid fibroblasts, but not in normal fibroblasts. Exogenously added insulin-like growth factor I enhanced the resistance of keloid fibroblasts to ceramide-induced apoptosis. Wort- mannin, a phosphatidylinositol 3 kinase inhibitor, suppressed the antiapoptotic action of insulin-like growth factor I in keloid fibroblasts. Our results suggest that keloid fibroblasts overexpressing insulin-like growth factor I receptor are resistant to apoptosis, thus allowing persistent proliferation and production of excessive extracellular matrix. J Invest Dermatol 115:1065-1071 2000
Abstract: We describe two cases in which three-dimensional miniplates broke after bilateral sagittal split osteotomy. The miniplates broke vertically and the cause was suspected to be excessive shear force on the osteotomy line because of unstable occlusion. In patients with unstable postoperative occlusions the osteosynthesis should be bicortical.
Abstract: OBJECTIVE: A comparative study of clinical mandibular stability following bilateral sagittal split osteotomies by means of monocortical versus bicortical osteosynthesis was undertaken. DESIGN: This retrospective study utilized cephalometric radiographs, which were taken at 1 week and 6 months postoperatively. SETTING: The research was carried out at the Department of Plastic and Reconstructive Surgery of the Nagasaki University School of Medicine. PATIENTS: A total of 32 patients who underwent only sagittal split osteotomies and mandibular set back in our unit was included in this study. Of these patients, 17 patients were osteosynthesized monocortically, and 15 patients were osteosynthesized bicortically. Main Outcome Measures: Four measurements--gonial angle (GA), mandibular plane (MP), SNB, and percentage of upper face to total face height (percent upper to total face)--were completed to evaluate postoperative mandibular movement. RESULT: Statistical analyses of cephalometric measurements (GA, MP, SNB, and percent upper face to total face height) showed that monocortical fixed mandibles were more changeable postoperatively on the GA and percent upper face to total face height, but MP and SNB showed no significant differences among the groups. CONCLUSION: These findings suggested that the postoperative excessive shear force stress, produced by the compressive action of the masseter muscle, transformed the mandibular shape as the distal segment rotated clockwise and proximal segment rotated counterclockwise. Consequently, the mandible was bent at the miniplate. It was concluded that bicortical osteosynthesis was more rigid against this shearing stress than monocortical osteosynthesis.
Abstract: Abstract
We report a case of late reconstruction of left ring and little metacarpal bone defects due to being caught in a fan of a garbage truck, using a double barrel osteocutaneous free parascapular flap. The initial treatment was carried out by orthopedic surgeons, and the patient was referred to our department for reconstruction of the hand defect one year later.
At our first examination, left ring and little proximal phalanx were pulled toward hamate bone due to metacarpal bone defects and contracture of dorsal scar, and had no stability, like floating fingers. Treatment was planned as two-stage operations, at the first stage of the surgery, a lengthening devices was applied to make up a space for insert the grafted bone. After spreading an enough space between a carpal bone and proximal phalanx, vascularized double barrel parascapular bone segment was transferred with the island skin as a free osteoctaneous flap.
　　Six months later, complete union of the vascularized bone segments with the recipient bones was recognized, and a good hand contour were also evident. The ring and little fingers maintained flexor function and normal sensation, and the patient resumed the power grip function.
Abstract: INTRODUCTION: It is generally agreed that an effective treatment for extra-articular ankylosis may be coronoidectomy and excision of scar tissue. But these conventional procedures have shown a high rate of recurrence of ankylosis due to heterotopic bone and fibrous tissue formation. OBJECTIVE AND PATIENT: We report a case in whom a coronoid osteotomy and insertion of a free abdominal flap was used to treat ankylosis of the mandible following radiotherapy for maxillary cancer. RESULTS: This procedure prevented recurrence of ankylosis by heterotopic bone and fibrous tissue formation. In addition, this flap reduced the risk of postoperative infection and promoted primary healing. CONCLUSION: The procedure, coronoidectomy and insertion of a free flap, was successful because the well-vascularized musculocutaneous flap occupied the dead space, and replaced the shortage of oral mucosa consequently inhibiting the recurrence of extra-articular ankylosis.
Abstract: The comparative study of neurosensory disturbance of the inferior alveolar nerve after bilateral sagittal split osteotomies was carried out. The 112 patients who underwent bilateral sagittal split osteotomies were divided into two groups: one group consisted of 62 patients (124 osteotomy sites) who received bicortical osteosynthesis using the lag screw principle (bicortical fixation group), and the other group consisted of 52 patients (104 osteotomy sites) who underwent monocortical osteosynthesis using miniplates (monocortical fixation group). The incidence of neurosensory disturbance of the inferior alveolar nerve as well as its recovery course was compared by patients' interview and Semmes-Weinstein pressure esthesiometer. Mean follow-up period was 12 months (minimum 3 months, maximum 36 months). The incidences of sensory disturbance of both groups were not significantly different at 2 weeks postoperatively. During the period 6 to 12 months postoperatively, the number of patients having light touch sensory disturbance was significantly less in the monocortical fixation group than in the bicortical fixation group. Moreover, the number of patients complaining of numbness during 6 to 18 months postoperatively was significantly less in the monocortical fixation group. These findings suggested that the monocortical osteosynthesis had less damage on the inferior alveolar nerve, leading to the better restoration of neurosensory disturbance in patients in whom the nerve damage was moderate.
Abstract: OBJECTIVE: The implantation of atelocollagen matrix on the denuded surface of palatal bone following cleft palate repair has been used because it enhances wound healing. This study was performed to determine whether the beneficial effect of atelocollagen matrix implantation on the prevention of scar tissue contraction also inhibits the scar's interference with the growth of maxillary bone. METHOD: Fifty New Zealand White rabbits (aged 4 weeks) underwent palatal mucoperiosteal denudation, and etelocollagen matrix was implanted on the left palatal process. The opposite side was left open as a control. RESULTS: Histopathologically, the implantation side exhibited early infiltration of mononuclear cells and fibroblasts, and better growth of connective tissue strands and epithelium. In addition, the formation of rate ridges were seen that were similar to the normal mucosa. The bone of the atelocollagen-implanted side was covered with regenerated periosteum-like layers, but that of the control side was lined by granulation tissue, suggesting the existence of continuous inflammation on the periosteal region. When the animals reached adulthood (aged 24 weeks), the areas of scars and palatal processes, palatal shelf width, molar teeth incline, and bone mineral contents were measured and compared between sides. The atelocollagen-applied scars showed less contraction, the area and width of atelocollagen-implanted palatal processes showed more satisfactory growth, and the dental arch deformity was suppressed in comparison with the control side. CONCLUSIONS: Our results suggest that the use of atelocollagen matrix on the denuded bone surface following cleft palate repair decreases the scar's effect on maxillary growth.
